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This dissertation is composed of three chapters. While the chapters pertain to very different contexts, an overarching theme is the analysis of human behavior in response to policies that are inherently economic.The first chapter is the product of joint work with Justin Holz and Rafael Jimenez Duran. It studies repugnance towards price gouging. Emergencies like natural disasters or pandemics trigger sharp price increases for essential products. Anti-price gouging laws are ubiquitous and people take costly actions to report violators to law-enforcement agencies, which suggests that they value punishing sellers that spike prices in these situations. This chapter uses a field experiment to understand individuals' willingness to report sellers who increase the price of personal protective equipment at the height of the COVID-19 pandemic. We argue that reporting decisions contain information about repugnance to price gouging and find that willingness to pay to report is non-trivial and heterogeneous. We also find evidence that repugnance is partly due to distaste for seller profits, depending on the product. These results suggest that regulation discussions would benefit from incorporating repugnance into welfare and from addressing products separately.The second chapter focuses in the use of temporary driving restrictions as a tool for air quality management in Mexico City. Road congestion is understood to be a major source of urban air pollution and is also associated with other large non-health-related costs. Millions of people live in cities in which the number of cars on the road is controlled by allowing or prohibiting the use of a car on a given day depending on its license plate number. The empirical evidence available suggests little benefit from these programs;the policy increases the marginal cost of using the road for some users while decreasing it for others and incentivizes the acquisition of extra vehicles. This chapter studies the effect of temporary increases in the stringency of the restrictions as an add-on policy intended to alleviate extreme pollution events. The increased restrictions are triggered by Ozone levels surpassing a pre-specified threshold. This, coupled with the fact that said threshold was modified several times between 2005 and 2018, allows us to identify the effect of the policy. We document a sizable increase in the average speed of cars in the city during restricted days. This suggests the policy does alleviate congestion. We also observe a reduction on Carbon Monoxide and Ozone concentration, but these results are not robust to changes in the specification's functional form. While we cannot explicitly quantify welfare effects, the minor improvements are unlikely to compensate the major disruption in the commuter network without serious investment in public transit alternatives.The third chapter, co-authored with Enrique Seira and Alan Elizondo, investigates the role of information disclosure on financial markets as tool for consumer protection. We implement a randomized control trial in the Mexican credit card market for a large population of indebted cardholders and measure the impact of disclosures of interest rate and time required to pay outstanding debt on default, indebtedness, account closings, and credit scores;these disclosures are required by law in the United States. We also test the effect debiasing warning messages and social comparison information has on the same outcomes. We find that providing salient interest rate disclosures had no effects, while comparisons and debiasing messages had only modest and short-lived effects at best. We conduct extensive external validity exercises in several banks, with different disclosures, and with actual policy mandates. We conclude the null result is robust. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
ABSTRACT
Purpose: This paper aims to investigate potential consumers' willingness to pay for robot-delivered services in travel, tourism and hospitality, and the factors that shape their willingness to pay. Design/methodology/approach: An online survey yielded a sample of 1,573 respondents from 99 countries. Independent samples t-test, Analysis of variance (ANOVA), cluster, factor and regression analyses were used. Findings: Respondents expected to pay less for robot-delivered services than human-delivered services. Two clusters were identified: one cluster willing to pay nearly the same price for robotic services as for human-delivered services, whilst the other expected deep discounts for robotic services. The willingness-to-pay was positively associated with the attitudes towards robots in tourism, robotic service experience expectations, men and household size. It was negatively associated to travel frequency, age and education. Research limitations/implications: The paper's main limitation is its exploratory nature and the use of a hypothetical scenario in measuring respondents' willingness to pay. The data were gathered prior to the COVID-19 pandemic and do not reflect the potential changes in perceptions of robots due to the pandemic. Practical implications: Practitioners need to focus on improving the attitudes towards robots in tourism because they are strongly and positively related to the willingness to pay. The marketing messages need to form positive expectations about robotic services. Originality/value: This is one of the first papers to investigate consumers' willingness to pay for robot-delivered services in travel, tourism and hospitality and factors that shape their willingness to pay. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
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Background During the promotion of category-based management for community healthcare institutions （class 1 institutions obtain the financial security，and class 2 institutions implement a performance management system），how to appropriately determine the security level and scientifically evaluate the performance is a difficulty to tackle for health administrative departments. Objective To assess the operational efficiency of community healthcare institutions with the data envelopment analysis（DEA） using the information of costs of these institutions calculated using the equivalent method，then attempt to develop an input and management model of integrating cost accounting and performance management for these institutions，providing a theoretical basis for accurate and scientific input of various resources into the community through cost measurement with equivalent method，and a data basis for performance assessment in communities with different characteristics through efficiency evaluation. Methods The real data（financial status and staffing） of 14 community healthcare institutions during 2019 to 2020 were collected from their financial reports，hospital information system，maternal and child healthcare information system，chronic disease management information system，as well as focus group interviews. The equivalent method was used to calculate the total costs of medical services and public health services. The super-efficiency DEA was used to evaluate and analyze the operational efficiency of the 14 sample institutions. Results （1）The average cost of one equivalent service（a general medical outpatient service lasting for 15 minutes was defined as one standard service equivalent unit） was 67.64 yuan in 2019 and 69.80 yuan in 2020 for the 14 institutions. The average cost of one equivalent essential medical service was higher than that of one equivalent public health service in both 2019（167.14 yuan vs 18.86 yuan） and 2020（215.43 yuan vs 19.78 yuan）. The institutions demonstrated significant differences in the average cost of one equivalent essential medical service and the average cost of one equivalent public health service. （2）Each institution had its own peculiar characteristics. For example，S1 institution mainly provided essential medical services，and had higher total equivalent essential medical services and efficiency than other institutions，while S9 institution focused on providing public health services，and had the highest efficiency in delivering public health services. （3）In 2020，the 14 institutions provided 134 800 equivalent COVID-19-related services，with a cost of 1.037 8 million yuan. （4）In 2019 and 2020，only two institutions were relatively overall efficient，and ≥ 50.0% institutions were pure technically efficient. The institutions with overall operational inefficiency were mainly caused by scale inefficiency primarily due to increasing returns to scale. Conclusion The equivalent method provides a relatively unified "scale" to standardize the service efficiency of different types of community healthcare institutions，provides support for health administrative departments implementing category-based compensation for the institutions，benefiting the featured and high-level development of community healthcare institutions. Either institutions delivering essential medical services or those delivering public health services，mainly present increasing returns to scale，suggesting that the efficiency of these institutions can be improved by increasing the human/financial/material input into the institutions and providing precise compensation for them. © 2023 Chinese General Practice. All rights reserved.
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The 2018 United Nations High-Level Meeting on Tuberculosis (UNHLM) set targets for case detection and TB preventive treatment (TPT) by 2022. However, by the start of 2022, about 13.7 million TB patients still needed to be detected and treated, and 21.8 million household contacts needed to be given TPT globally. To inform future target setting, we examined how the 2018 UNHLM targets could have been achieved using WHO-recommended interventions for TB detection and TPT in 33 high-TB burden countries in the final year of the period covered by the UNHLM targets. We used OneHealth-TIME model outputs combined with the unit cost of interventions to derive the total costs of health services. Our model estimated that, in order to achieve UNHLM targets, >45 million people attending health facilities with symptoms would have needed to be evaluated for TB. An additional 23.1 million people with HIV, 19.4 million household TB contacts, and 303 million individuals from high-risk groups would have required systematic screening for TB. The estimated total costs amounted to ~USD 6.7 billion, of which ~15% was required for passive case finding, ~10% for screening people with HIV, ~4% for screening household contacts, ~65% for screening other risk groups, and ~6% for providing TPT to household contacts. Significant mobilization of additional domestic and international investments in TB healthcare services will be needed to reach such targets in the future.
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BACKGROUND: Our study aimed to establish 'real-world' performance and cost-effectiveness of ovarian cancer (OC) surveillance in women with pathogenic germline BRCA1/2 variants who defer risk-reducing bilateral salpingo-oophorectomy (RRSO). METHODS: Our study recruited 875 female BRCA1/2-heterozygotes at 13 UK centres and via an online media campaign, with 767 undergoing at least one 4-monthly surveillance test with the Risk of Ovarian Cancer Algorithm (ROCA) test. Surveillance performance was calculated with modelling of occult cancers detected at RRSO. The incremental cost-effectiveness ratio (ICER) was calculated using Markov population cohort simulation. RESULTS: Our study identified 8 OCs during 1277 women screen years: 2 occult OCs at RRSO (both stage 1a), and 6 screen-detected; 3 of 6 (50%) were ≤stage 3a and 5 of 6 (83%) were completely surgically cytoreduced. Modelled sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) for OC were 87.5% (95% CI, 47.3 to 99.7), 99.9% (99.9-100), 75% (34.9-96.8) and 99.9% (99.9-100), respectively. The predicted number of quality-adjusted life years (QALY) gained by surveillance was 0.179 with an ICER cost-saving of -£102,496/QALY. CONCLUSION: OC surveillance for women deferring RRSO in a 'real-world' setting is feasible and demonstrates similar performance to research trials; it down-stages OC, leading to a high complete cytoreduction rate and is cost-saving in the UK National Health Service (NHS) setting. While RRSO remains recommended management, ROCA-based surveillance may be considered for female BRCA-heterozygotes who are deferring such surgery.
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During the 2020 COVID-19 epidemic, the U.S. Congress passed the CARES Act that (among other measures) provides direct payments to households. Using a large debit cards database, we analyze consumer expenditures following the stimulus payments. We observe zip code level daily transactions (approximately 12 million cards) before and immediately following the disbursements of stimulus checks. Empirical analysis exploits geographical variation in timing of federal deposits to identify marginal propensity to consume (MPC) for stimulus payments. We estimate between 0.29 (excluding banking) and 0.51 (all spend) of the rebate is spent within a few days of receipt. We find large cross-sectional heterogeneity with MPC estimates that are three times higher in magnitude in the most densely populated urban areas with higher cost-of-living. In areas with more restricted movement during the pandemic (as measured by Google workplace mobility), MPC estimates are approximately 60% higher. We reanalyze data from previous fiscal initiatives (2001 tax rebates and the 2008 fiscal stimulus) and find similar geographical differences. Collectively our results highlight an important shortcoming in fiscal policies that ignore local environment, particularly cross-sectional differences in cost-of-living across the United States. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
ABSTRACT
I consider a market for differentiated products with an online marketplace (the platform) and two types of firms. Marketplace firms sell through the platform. Branded firms sell to consumers directly and, if they choose, through the platform. When a branded firm joins the platform, the firm expands its reach beyond its branded website/physical store(s) to consumers who visit the platform for all their purchases. The drawback is that the firm has to pay a referral fee for all sales on the platform, some of which are from its loyal consumers who would otherwise have purchased from the firm directly. I investigate the role of the firm composition in determining the equilibrium outcome. Interestingly, a higher fraction of branded firms translates into more firms on the platform and intense price competition. In the midst of the COVID-19 pandemic, consumers who used to shop at physical stores turn to the platform. I show that if they do (do not) consider other products, more (fewer) branded firms will join the platform in equilibrium. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
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Purpose: This paper aims to propose an operation policy of multi-capacity room service robots traveling within a hotel. As multi-capacity robots can serve many requests in a single trip, improved operation policy can reduce the investment cost of robots. Design/methodology/approach: Using a mathematical model-based optimization technique, an optimal set of robots with minimum installation cost is derived while serving the entire room service demands. Through testing a variety of scenarios by changing the price and function of robots to be installed, insights that consider the various situations are offered. Findings: Though the increase in capacity saves much time for room service at a lower capacity level, the amount of time saved gradually decreases as the capacity increases. Besides, the installation strategy is divided into two cases depending on the purchase cost of robots. Research limitations/implications: Currently, the studies focusing on the adoption of service robots from an operations view are rarely be found. To reduce the burden of investment cost, this study takes the unique approach to improve the operation policy of service robots by using the multi-capacity robots. Practical implications: This study guides the hotel to install an adequate set of robots. The result confirms that the optimal installation set of robots is affected by various factors, such as the room service information, the hotel structure and the unit execution cycle. Originality/value: After the outbreak of COVID-19, people avoid face-to-face contact and interest in non-contact service is growing. This paper deals with the efficient way to implement non-contact delivery through logistic robots, a timely and important topic. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
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Psychotherapy has traditionally been delivered in person, but recent technological advances have made it possible to conduct remote treatments. There is currently strong evidence for the efficacy of guided self-help with online support from a therapist, but less is known about video-mediated psychotherapy. The COVID-19 pandemic has however forced many therapists to provide remote treatments. This transition might be especially trying for therapists of children and adolescents, but their experiences are underexplored. This study aimed to investigate their perceptions of video-mediated psychotherapy. Semi-structured interviews were conducted with 16 therapists and analyzed using thematic analysis. The therapists described how they struggled with technical and ethical issues and tried to overcome the loss of their usual therapeutic tools. They were concerned that the online format led to less effective treatments or could have negative effects, even if it might increase care availability. Generally, they felt frustrated, inadequate, and stressed, and experienced less job satisfaction. The therapists concluded that video-mediated sessions might be a good alternative for children and adolescents - provided the therapists themselves could determine for whom and when to offer video sessions. Implications of their experiences are discussed, including how psychotherapy training might have to incorporate issues related to remote psychotherapy. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
ABSTRACT
Background During the promotion of category-based management for community healthcare institutions （class 1 institutions obtain the financial security，and class 2 institutions implement a performance management system），how to appropriately determine the security level and scientifically evaluate the performance is a difficulty to tackle for health administrative departments. Objective To assess the operational efficiency of community healthcare institutions with the data envelopment analysis（DEA） using the information of costs of these institutions calculated using the equivalent method，then attempt to develop an input and management model of integrating cost accounting and performance management for these institutions，providing a theoretical basis for accurate and scientific input of various resources into the community through cost measurement with equivalent method，and a data basis for performance assessment in communities with different characteristics through efficiency evaluation. Methods The real data（financial status and staffing） of 14 community healthcare institutions during 2019 to 2020 were collected from their financial reports，hospital information system，maternal and child healthcare information system，chronic disease management information system，as well as focus group interviews. The equivalent method was used to calculate the total costs of medical services and public health services. The super-efficiency DEA was used to evaluate and analyze the operational efficiency of the 14 sample institutions. Results （1）The average cost of one equivalent service（a general medical outpatient service lasting for 15 minutes was defined as one standard service equivalent unit） was 67.64 yuan in 2019 and 69.80 yuan in 2020 for the 14 institutions. The average cost of one equivalent essential medical service was higher than that of one equivalent public health service in both 2019（167.14 yuan vs 18.86 yuan） and 2020（215.43 yuan vs 19.78 yuan）. The institutions demonstrated significant differences in the average cost of one equivalent essential medical service and the average cost of one equivalent public health service. （2）Each institution had its own peculiar characteristics. For example，S1 institution mainly provided essential medical services，and had higher total equivalent essential medical services and efficiency than other institutions，while S9 institution focused on providing public health services，and had the highest efficiency in delivering public health services. （3）In 2020，the 14 institutions provided 134 800 equivalent COVID-19-related services，with a cost of 1.037 8 million yuan. （4）In 2019 and 2020，only two institutions were relatively overall efficient，and ≥ 50.0% institutions were pure technically efficient. The institutions with overall operational inefficiency were mainly caused by scale inefficiency primarily due to increasing returns to scale. Conclusion The equivalent method provides a relatively unified "scale" to standardize the service efficiency of different types of community healthcare institutions，provides support for health administrative departments implementing category-based compensation for the institutions，benefiting the featured and high-level development of community healthcare institutions. Either institutions delivering essential medical services or those delivering public health services，mainly present increasing returns to scale，suggesting that the efficiency of these institutions can be improved by increasing the human/financial/material input into the institutions and providing precise compensation for them. © 2023 Chinese General Practice. All rights reserved.
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OBJECTIVES: To identify the main cost components included in the economic evaluations of measles outbreaks, their items and cost drivers, and evaluate the quality of costing methodology, analyzing the key features that may affect the validity of these studies in countries with different income levels. METHODS: We systematically searched multiple databases EMBASE, MEDLINE (via PubMed), Biblioteca Virtual em Saúde do Ministério da Saúde (BVS MS), NHS Economic Evaluation Database (NHS EED) and NHS Health Technology Assessment (NHS HTA) (via The Centre for Reviews and Dissemination Library - CRD), and EconLit, SCOPUS, and Web of Science, selecting cost analysis and cost of illness studies (COI) of measles outbreaks. Two independent reviewers screened articles for relevance and extracted the data. The quality of costing methods was assessed using a guide to critical evaluation of COI studies. We performed a qualitative narrative synthesis. RESULTS: Twenty-two studies were reviewed. Most studies evaluated outbreaks that occurred from 2011 to 2013 and 2017 to 2019. Total costs varied from $40,147 to $39.3 million. Per case cost varied from $168 to $49,439. The main drivers of measles outbreak costs were outbreak response, personnel, and productivity losses. Most studies (20/22) did not report the costing methodology adopted, the degree of disaggregation used in the identification and measurement of resource and costs components and the method for the valuation of resource and cost components. CONCLUSIONS: The quality of the costing methodology, its transparency and accuracy are essential to the validity of these studies results and their potential use to allocate public health resources in the most efficient manner and to inform measles outbreak control strategies, with rapid and effective response.
Subject(s)
Disease Outbreaks , Measles , Humans , Cost-Benefit Analysis , Public Health , Measles/epidemiology , Measles/prevention & control , Research ReportABSTRACT
The outbreak of COVID-19 has had destructive influences on social and economic systems as well as many aspects of human life. In this study, we aimed to estimate the economic effects of COVID-19 at the individual and societal levels during a fiscal year. This cost of illness analysis was used to estimate the economic burden of COVID-19 in Iran. Data of the COVID-19 patients referred to the hospitals affiliated to Bushehr University of Medical Sciences in 2021 were collected through the Hospital Information System (HIS). The study methodology was based upon the human capital approach and bottom-up technique. The COVID-19 pandemic has resulted in 9711 confirmed hospital cases and 717 deaths in Bushehr province during the study period. The direct and indirect costs were estimated to be $1446.06 and $3081.44 per patient. The economic burden for the province and country was estimated to be $43.97 and $2680.88 million. The results showed that the economic burden of this disease particularly premature death costs is remarkably high. Therefore, in order to increase the resiliency of the health system and the stability in service delivery, preventive-oriented strategies have to be more seriously considered by policymakers.
Subject(s)
COVID-19 , Pandemics , Humans , Cost of Illness , Disease Outbreaks , Hospitals , Health Care CostsABSTRACT
BACKGROUND: The COVID-19 pandemic disrupted TB services worldwide, leading to diagnostic delays. There have been few published reports describing how the pandemic affected people's pathway to diagnosis from their own perspectives. We sought to evaluate the impact on the pandemic on people's experiences obtaining a TB diagnosis. METHODS: We performed a mixed-methods study, enrolling newly diagnosed TB patients from 12 health centers in Lima, Peru. We used structured surveys to quantify diagnostic delay, defined as the time between symptom onset and diagnosis, and in-depth interviews to understand the ways in which the pandemic affected the pathway to care. We compared diagnostic delay between patients enrolled during the first year of the pandemic to those diagnosed after using a Wilcoxon rank-sum test. We used an inductive content analysis approach to analyze interview content related to the pandemic. RESULTS: We enrolled 51 patients during November 2020-April 2021 (during the first year of the pandemic) and 49 patients during October 2021-February 2022. Median diagnostic delay was longer for patients diagnosed during the first year of the pandemic (median 15 [IQR 5-26] weeks compared to 6 [IQR 3-18] weeks, p = 0.027). Qualitative analysis of 26 interviews revealed that the pandemic affected participants' care-seeking behavior and their ability to access to TB diagnostic services, particularly for those diagnosed in the first year of the pandemic. Many participants initially had their symptoms attributed to COVID-19, resulting in delayed TB evaluation and additional costs for COVID-19 treatment. CONCLUSIONS: The COVID-19 pandemic impacted multiple steps in the pathway to care for TB patients in Lima, causing delays in TB diagnosis. These findings demonstrate how the shifting of health care resources to prioritize COVID-19 can lead to collateral damage for people with TB and other conditions.
Subject(s)
COVID-19 , Tuberculosis , Humans , COVID-19/diagnosis , Delayed Diagnosis , Pandemics , Peru/epidemiology , Cross-Sectional Studies , Tuberculosis/diagnosis , Tuberculosis/epidemiology , Tuberculosis/therapy , COVID-19 Drug TreatmentABSTRACT
PURPOSE Historically, African Americans (AA) have been underrepresented in nutrition-related behavioral research despite their disproportionate higher risk of cardiovascular disease (CVD). The Nutritious Eating with Soul (NEW Soul) Study is one of the first of its kind to recruit an AA only study group to examine CVD prevention via a clinical trial to examine changes in CVD risk factors across two cohorts who are randomly assigned to a plant-based, soul food vegan diet or low-fat omnivorous (omni) diet. The purpose of cost effectiveness analysis (CEA) is to inform clinical and policy decisions and the costs of interventions that society is willing to pay for. However, few studies have examined the cost effectiveness of behavioral interventions for AA adults. The purpose of this study was to evaluate the cost effectiveness of the nutrition and behavior change interventions of the NEW Soul Study, from a societal perspective, by examining direct costs to deliver the intervention, and indirect costs reported by participants associated with intervention adherence. METHODS Primary data were collected from AA adults (n=105) between the ages of 18-65 from the Midlands SC region, who enrolled in the NEW Soul Study, across two cohorts, and were identified as having overweight or obesity (BMI 25-49.9 kg/m2). Upon completion of baseline assessment of weight, and other laboratory measures, participants were randomized to follow a vegan or low-fat omni diet. A cost effectiveness analysis (CEA) of this randomized control trial is based on one-year outcomes collected in April 2019 for Cohort 1 and June-July 2020 for Cohort 2. An incremental cost effectiveness ratio (ICER) over the one-year study period was calculated based on the intervention (direct) and societal (indirect) costs and weight loss. Total Costs = Costs to deliver the intervention (ingredients for cooking demonstrations, meals) + participants' average cost of weekly groceries + average weekly costs of dining out. Quality adjusted life year (QALY) was calculated based on Short Form-12 survey responses that were collected at baseline and one year. Variations in weight loss between cohorts 1 and 2 before COVID-19 and during COVID-19 were assessed using a difference-in-difference (DD) study design. RESULTS The incremental cost effectiveness ratio (ICER) was $2,888.57 per pound of weight loss. The results fall within quadrant II of the cost effectiveness plane which indicates that the vegan diet group, as compared to the omni diet group was more cost effective, as participants in that diet group experienced greater weight loss in addition to the intervention costing less. Results from the least squares means estimate from DD models (adjusted for covariates) reveal that both diet groups experienced some gains in QALY from baseline to 12 months (omni baseline = 0.7889;omni 12 months= 0.804;vegan baseline =0.8027;vegan 12 months = 0.808), however there was no statistically significant DD in QALY between diet groups (Pr > t = 0.6485). Pre-COVID, Cohort 1 participants lost an average of 10.2 pounds at 12 months from baseline. During COVID, Cohort 2 participants lost an average of 3.7 pounds at 12 months from baseline. The difference-in-differences in weight loss pre-COVID and during COVID by diet group revealed a statistically significant change in weight loss at 12 months compared to baseline between cohorts 1 and 2 for the vegan diet group (p=0.0408). Pre-COVID (C1), the vegan diet group lost an average of 11 pounds. During COVID (C2), the vegan diet group lost an average of 3.47 pounds.CONCLUSIONS The vegan diet intervention produced clinically relevant weight loss at a lower cost and was therefore cost-effective. Both diet groups experienced similarly minimal gains in QALYs and the DD in QALYs between the vegan and omni groups was not statistically significant. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
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Background: The COVID-19 pandemic has brought healthcare systems to the brink of collapse worldwide, imposing relevant economic challenges. Objective: To analyze the costs related to the impact of the first wave of the COVID-19 pandemic on human resource management in a Portuguese hospital. Methodology: Economic, retrospective, and single-center study. This study analyzed the costs of absenteeism, hiring new staff, and overtime work by health professionals (nurses, physicians, operational assistants, and diagnostic and therapeutic technicians) and compared data from March 1 to May 31, 2020 to the same period in 2019 to determine differences in costs. Results: Data from 6,994 health professionals were included. Compared to 2019, an additional 8,817,199.84€ were spent on staff in this trimester (absenteeism: €6,842,284.64;hiring new staff: €363,540.03;overtime work: €1,611,375.17). Conclusion: In the first trimester of the COVID-19 pandemic, the overall costs with health professionals almost tripled, representing almost €9 million more than in the same period in 2019. © 2021, Escola Superior de Enfermagem de Coimbra. All rights reserved.
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OBJECTIVES: This study aimed to estimate the direct medical costs due to hospitalizations by COVID-19 in Colombia and to identify their cost drivers in Colombia. METHODS: This is a retrospective cost-of-illness study of COVID-19 in Colombia. We estimated direct medical costs using data from patients insured to a Benefit Plan Administrator Company, between March 15, 2020 and May 29, 2020. Absolute and relative frequencies, averages, medians, and interquartile ranges (IQRs) were used to characterize the population and estimate the costs of hospitalized patients with COVID-19. We stratified the cost analysis by sex, age groups, comorbidities, and type of hospitalization (general ward and intensive care unit [ICU]). Cost drivers were calculated from a generalized linear model. RESULTS: We studied 113 confirmed patients, 51.3% men. On average, the hospital length of stay was 7.3 (± 6.2) days. A person hospitalized with COVID-19 reported median costs of $1688 (IQR 788-2523). In women, this cost was $1328 (IQR 463-2098); in men, this was 1.4 times greater. The median cost for ICU was $4118 (IQR 2069-5455), 3 times higher than those hospitalized only in the general ward. Admission to the ICU, having 1 comorbidity, length of stay, high blood pressure, having 5 comorbidities, and being treated in the city of Cartagena were statistically significant with direct medical costs. CONCLUSIONS: Our study provides an idea of the magnitude of costs needed to hospitalize a COVID-19 case in Colombia. Other studies in Colombia have assessed the costs of hospitalization for infectious diseases such as influenza, costs significantly lower than those described here.
Subject(s)
COVID-19 , COVID-19/epidemiology , Colombia/epidemiology , Female , Hospitalization , Humans , Intensive Care Units , Male , Retrospective StudiesABSTRACT
The process of developing and marketing new pharmaceuticals in the United States is driven by a need to maximize returns to shareholders. This results all too often in the production of new medications that are expensive and of marginal value to patients and society. In line with our heightened awareness of the importance of social justice and public health-and in light of our government's alliance with private companies in bringing us COVID-19 vaccines-we need to reconsider how new pharmaceuticals are developed and distributed. Accordingly, we propose the creation of a new agency of the Food and Drug Administration (FDA) that would direct the whole process. This agency would fund the research and development of high-value medications, closely monitor the clinical studies of these new drugs, and manage their distribution at prices that are value-based, fair, and equitable.
Subject(s)
Drug Development , Drug Industry , United States Food and Drug Administration , COVID-19 Vaccines , Drug Development/legislation & jurisprudence , Drug Development/organization & administration , Humans , Marketing , Pharmaceutical Preparations , United StatesABSTRACT
BackgroundThis study aimed to compare the testing strategies for COVID‐19 (i.e., individual, simple pooling, and matrix pooling) in terms of cost.MethodsWe simulated the total expenditures of each testing strategy for running 10,000 tests. Three parameters were used: positive rate (PR), pool size, and test cost. We compared the total testing costs under two hypothetical scenarios in South Korea. We also simulated country‐specific circumstances in India, South Africa, South Korea, the UK, and the USA.ResultsAt extreme PRs of 0.01% and 10%, simple pooling was the most economic option and resulted in cost reductions of 98.0% (pool size ≥80) and 36.7% (pool size = 3), respectively. At moderate PRs of 0.1%, 1%, 2%, and 5%, the matrix pooling strategy was the most economic option and resulted in cost reductions of 97.0% (pool size ≥88), 86.1% (pool size = 22), 77.9% (pool size = 14), and 59.2% (pool size = 7), respectively. In both hypothetical scenarios of South Korea, simple pooling costs less than matrix pooling. However, the preferable options for achieving cost savings differed depending on each country's cost per test and PRs.ConclusionsBoth pooling strategies resulted in notable cost reductions compared with individual testing in most scenarios pertinent to real‐life situations. The appropriate type of testing strategy should be chosen by considering the PR of COVID‐19 in the community and the test cost while using an appropriate pooling size such as five specimens.
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Objectives: The objective of this paper is to study under which circumstances wearable and health app users would accept a compensation payment, namely a digital dividend, to share their self-tracked health data. Methods: We conducted a discrete choice experiment alternative, a separated adaptive dual response. We chose this approach to reduce extreme response behavior, considering the emotionally-charged topic of health data sales, and to measure willingness to accept. Previous experiments in lab settings led to demands for high monetary compensation. After a first online survey and two pre-studies, we validated four attributes for the final online study: monthly bonus payment, stakeholder handling the data (e.g., health insurer, pharmaceutical or medical device companies, universities), type of data, and data sales to third parties. We used a random utility framework to evaluate individual choice preferences. To test the expected prices of the main study for robustness, we assigned respondents randomly to one of two identical questionnaires with varying price ranges. Results: Over a period of three weeks, 842 respondents participated in the main survey, and 272 respondents participated in the second survey. The participants considered transparency about data processing and no further data sales to third parties as very important to the decision to share data with different stakeholders, as well as adequate monetary compensation. Price expectations resulting from the experiment were high;pharmaceutical and medical device companies would have to pay an average digital dividend of 237.30/month for patient generated health data of all types. We also observed an anchor effect, which means that people formed price expectations during the process and not ex ante. We found a bimodal distribution between relatively low price expectations and relatively high price expectations, which shows that personal data selling is a divisive societal issue. However, the results indicate that a digital dividend could be an accepted economic incentive system to gather large-scale, self-tracked data for research and development purposes. After the COVID-19 crisis, price expectations might change due to public sensitization to the need for big data research on patient generated health data. Conclusion: A continuing success of existing data donation models is highly unlikely. The health care sector needs to develop transparency and trust in data processing. An adequate digital dividend could be an effective long-term measure to convince a diverse and large group of people to share high-quality, continuous data for research purposes. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
ABSTRACT
Aims: To describe (i) self-reported changes in drug use and (ii) trends in price, perceived availability, and perceived purity of illicit drugs, among people who regularly use ecstasy/ 3,4-methylenedioxymethamphetamine (MDMA) and other illicit stimulants in Australia following COVID-19 and associated restrictions. Design: Annual interviews with cross-sectional sentinel samples conducted face-to-face in 2016-19 and via video conferencing or telephone in 2020. Data were collected via an interviewer-administered structured questionnaire. Setting: Australian capital cities. Participants: Australians aged 16 years or older who used ecstasy/MDMA and other illicit stimulants on a monthly or more frequent basis and resided in a capital city, recruited via social media and word-of-mouth (n ~ 800 each year). Measurements: Key outcome measures were self-reported illicit drug market indicators (price, purity and availability) and, in 2020 only, perceived change in drug use (including alcohol and tobacco) since March 2020 and reasons for this change. Findings: For most drugs, participants reported either no change or a reduction in their use since COVID-19 restrictions were introduced. Ecstasy/MDMA was the drug most frequently cited as reduced in use (n = 552, 70% of those reporting recent use), mainly due to reduced opportunities for socialization. While market indicators were largely stable across most drugs, the odds of perceiving MDMA capsules as 'high' in purity decreased compared with 2016-19 [adjusted odds ratio (aOR) = 0.72, 95% confidence interval (CI) = 0.53-0.99], as did perceiving them as 'easy' to obtain (aOR = 0.42, CI = 0.26-0.67). The odds of perceiving cocaine and methamphetamine crystal as 'easy' to obtain also decreased (aOR = 0.67, CI = 0.46-0.96 and aOR = 0.12, CI = 0.04-0.41, respectively). Conclusions: After COVID-19-related restrictions were introduced in Australia, use of ecstasy/MDMA, related stimulants and other licit and illicit drugs mainly appeared to remain stable or decrease, primarily due to impediments to socialization. (PsycInfo Database Record (c) 2022 APA, all rights reserved)